Physical function outcome in cervical radiculopathy patients after physiotherapy alone compared with anterior surgery followed by physiotherapy: a prospective randomized study with a 2-year follow-up

Spine (Phila Pa 1976). 2013 Feb 15;38(4):300-7. doi: 10.1097/BRS.0b013e31826d2cbb.


Study design: Prospective randomized study.

Objective: To investigate differences in physical functional outcome in patients with radiculopathy due to cervical disc disease, after structured physiotherapy alone (consisting of neck-specific exercises with a cognitive-behavioral approach) versus after anterior cervical decompression and fusion (ACDF) followed by the same structured physiotherapy program.

Summary of background data: No earlier studies have evaluated the effectiveness of a structured physiotherapy program or postoperative physical rehabilitation after ACDF for patients with magnetic resonance imaging-verified nerve compression due to cervical disc disease.

Methods: Our prospective randomized study included 63 patients with radiculopathy and magnetic resonance imaging-verified nerve root compression, who were randomized to receive either ACDF in combination with physiotherapy or physiotherapy alone. For 49 of these patients, an independent examiner measured functional outcomes, including active range of neck motion, neck muscle endurance, and hand-related functioning before treatment and at 3-, 6-, 12-, and 24-month follow-ups.

Results: There were no significant differences between the 2 treatment alternatives in any of the measurements performed (P = 0.17-0.91). Both groups showed improvements over time in neck muscle endurance (P ≤ 0.01), manual dexterity (P ≤ 0.03), and right-handgrip strength (P = 0.01).

Conclusion: Compared with a structured physiotherapy program alone, ACDF followed by physiotherapy did not result in additional improvements in neck active range of motion, neck muscle endurance, or hand-related function in patients with radiculopathy. We suggest that a structured physiotherapy program should precede a decision for ACDF intervention in patients with radiculopathy, to reduce the need for surgery.

Level of evidence: 2.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biomechanical Phenomena
  • Cervical Vertebrae / physiopathology
  • Cervical Vertebrae / surgery*
  • Combined Modality Therapy
  • Decompression, Surgical*
  • Female
  • Follow-Up Studies
  • Hand Strength
  • Humans
  • Intervertebral Disc / physiopathology
  • Intervertebral Disc / surgery*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Motor Activity
  • Muscle Strength
  • Neck Muscles / physiopathology*
  • Neck Pain / diagnosis
  • Neck Pain / physiopathology
  • Neck Pain / therapy
  • Physical Therapy Modalities*
  • Prospective Studies
  • Radiculopathy / diagnosis
  • Radiculopathy / physiopathology
  • Radiculopathy / surgery
  • Radiculopathy / therapy*
  • Recovery of Function
  • Spinal Fusion*
  • Sweden
  • Time Factors
  • Treatment Outcome